Provider Demographics
NPI:1528400389
Name:ELITE CARE SERVICES
Entity Type:Organization
Organization Name:ELITE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SON
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-982-4068
Mailing Address - Street 1:2000 W MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5446
Mailing Address - Country:US
Mailing Address - Phone:704-982-4068
Mailing Address - Fax:
Practice Address - Street 1:42424 MOSS LANE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NC
Practice Address - Zip Code:28127
Practice Address - Country:US
Practice Address - Phone:704-982-4068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-084-075320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities